1. Introduction
Cleft lip and palate (CLP) ranks among the most prevalent craniofacial anomalies affecting the head and neck [
1], with a global incidence ranging from 1 to 7 per 1000 live births [
2,
3]. Constituting about 65% of non-tumor head and neck malformations, CLP poses challenges in feeding, hearing, speech, and psychological well-being [
4,
5]. The severity of the cleft can range from a small notch on the upper lip to a huge gap in the roof of the mouth, so this kind of malformation requires great attention and more understanding [
6,
7]. To address the multidimensional nature of CLP, a collaborative effort involving surgeons, orthodontists, and speech therapists is essential [
8]. CLP patients also have esthetic and psychological problems, so it is preferable to manage them with the help of a team of specialists [
7,
9,
10]. Of particular significance is the role of orthodontists, as efficient presurgical orthopedic management (PSO) before surgical lip closure is recognized as the foundational step in CLP treatment [
11,
12,
13]. Initiated in the first days of life, PSO proves advantageous by enhancing feeding, reducing the cleft gap, and thereby improving the outcomes of subsequent palatal and lip repair procedures [
14,
15]. Prior to surgical lip closure, orthopedic treatment further aims to optimize maxillary–mandibular relationships for superior surgical outcomes [
16].
Different surgical techniques are used for lip closure, but the ones most commonly used by surgeons are the Millard or Fisher technique for the repair of the unilateral cleft or the Millard technique for the repair of the bilateral cleft [
17]. The main advantages of these surgical procedures are to complete the orbicularis oris muscle, gain symmetry, and, most importantly, provide cosmetics [
18].
The historical progression of PSO includes Hoffmann’s introduction of a head cap in 1686, which applied retraction force to the premaxillary segment [
19]. Advancements such as the use of silver wire to approximate alveolar segments were introduced [
20]. In 1993, Grayson et al. introduced the Nasoalveolar Molding (NAM) concept, employing an intraoral plate with a nasal stent to guide growth and alignment in infants with CLP [
21]. DynaCleft, a recent innovation, substitutes the intraoral plate with a nasal elevator and paper tape, simplifying the procedure [
22].
Despite these advancements, a less explored yet promising technique is lip taping. Clinical assessments in a small number of trials, such as those by Dawjee et al. (2014) and Pool and Farnworth (1994), showed that it was useful in minimizing the cleft gap and molding maxillary alveolar segments [
23]. Described as a simple and cost-effective approach, lip taping represents a valuable addition to the armamentarium of CLP treatment options [
24]. As the field of CLP treatment evolves, continuous research and the introduction of new techniques, such as DynaCleft, signify ongoing progress and a commitment to enhancing patient outcomes [
22].
The use of PSIOs is currently widely accepted [
25,
26] but there are disagreements over the long-term advantages of this kind of CLP therapy [
27,
28,
29,
30]. Nasoalveolar molding, lip taping, and other PSIO approaches offer the best treatment outcomes for presurgical newborn orthopedics, according to several systematic evaluations [
11,
31,
32,
33]. Diverse levels of awareness regarding cleft lip and palate (CLP) have been documented across rural and urban areas, highlighting regional disparities [
34,
35]. Importantly, parents’ education levels and knowledge about CLP are closely linked to the decision to forego treatment, thereby elevating the risk of adverse outcomes, including mortality in severe cases [
35,
36]. Furthermore, delays in surgical interventions and non-compliance with specialist instructions, such as adherence to presurgical orthopedic treatment, may result in unfavorable clinical outcomes, negatively impacting both the child and the family [
37]. Given that presurgical orthopedics (PSO) is recommended as an initial therapeutic approach, with caregivers assuming a pivotal role in the care of children with CLP, lip taping is one of the simplest approaches for this treatment. Lip taping works to establish an acceptable maxillary–mandibular relationship, restore normal oral function, make surgical lip closure easier, and improve the general outcome [
16]. This study aimed to quantitatively assess caregivers’ perceptions and experiences with the use of lip taping as an integral component of presurgical orthopedics. The limited available data on caregivers’ opinions about PSO underscore the pressing need for this current study, which seeks to bridge gaps in understanding and optimize caregiver involvement in the CLP treatment process. Caregivers of patients with cleft lip and palate from different areas of Iraq and from different medical centers that provide medical treatment for these patients were interviewed. The null hypothesis was evaluated comparatively using statistical tests.
4. Discussion
As we know, cleft lip and palate is a common congenital anomaly with an estimated incidence of 1–7 per 1000 births [
3]. The failure of the fronto-nasal and maxillary processes to fuse leads to this anomaly, which can cause a cleft of variable severity that can penetrate the lip, alveolus, and nasal floor [
38]. Such patients usually have several dental and medical problems, such as natal and neonatal teeth, microdontia, ectopically erupted teeth, supernumerary teeth, and congenitally missing teeth. In addition, they have many medical problems, like feeding problems, ear and chest infections, and speech difficulties that require directing the family to overcome them [
39,
40].
The first line for management of cleft lip and palate in infants is to start with an orthopedic treatment in the first days of their lives. Despite the benefits of PSIOs, great controversy still exists globally related to the orthopedic management of infants with CLP before surgery [
41]. Both caregivers and clinicians find it challenging to deal with infants with CLP during their first days of life [
42]. Since surgical correction is considered the ultimate goal to correct the anatomical defect, it is sometimes difficult to provide this surgical correction during the early months of an infant’s life. As a result, the family usually faces considerable adverse functional and psychological problems that require medical intervention. That is why PSIOs are thought to reduce these problems and provide a smooth transitory period before surgery [
43].
Given the limited evidence on caregivers’ experiences with cleft lip and palate (CLP) management, this retrospective study aimed to assess caregivers’ experiences with using lip taping as a presurgical orthopedic treatment. The hypothesis sought to examine this experience in relation to caregivers’ education, area of residency, age, and whether they had affected siblings.
The study revealed varying caregiver experiences with lip taping, emphasizing the impact of the area of residency on awareness levels regarding CLP defects. Different levels of awareness were noted in urban and rural areas [
34,
35]. Additionally, caregivers’ education emerged as a crucial factor, with low education levels correlating closely with a tendency to leave children untreated [
35,
36].
The results indicated that 90.0% of caregivers faced no difficulties with lip taping, with a significant correlation observed among the educated participants. Moreover, 93.4% acknowledged the efficacy of lip taping in retracting the premaxillary segment, a percentage significantly associated with caregivers’ education. This underscores the pivotal role of education in ensuring optimal care for infants with CLP. Age-related findings indicated a significant correlation between caregiver age, efficacy in retracting the premaxillary segment, and the absence of embarrassment among those above 30 years. This emphasizes the importance of caregiver age in delivering desirable care for infants with CLP. A noteworthy correlation was observed between area of residency and caregivers’ attitudes, with 76.3% residing in urban areas. These findings align with previous research highlighting the impact of the residency on parental and caregiver awareness and experience [
34,
35]. Interestingly, no significant relationship was found between caregiver experience and having affected siblings, possibly influenced by the limited number of participants with affected siblings, hindering a robust comparison.
Magyar and his colleagues conducted a survey-based study in 2022 that confirmed the findings of this study [
44]. The study utilized a 32-item questionnaire following NAM therapy and involved 17 families. The study showed a good parental experience and satisfaction with the results of the therapy, and they would advise other caregivers to use it with CLP patients.
Another study carried out in 2016 by Hopkins and his colleagues [
45] explored the experiences of eight mothers and four fathers who were interviewed and were taking care of infants with CLP who were receiving molding. They were keen on the treatment process and revealed the benefits of such treatment, which supports our findings. In addition to the previous studies, in 2016, another study was carried out by 53 participating CLP caregivers whose infants were receiving treatment by NAM. Most of those caregivers stated that the molding technique made a great change in the patient’s lip (50 caregivers, 94.3%), palate (48 caregivers, 90.5%), and nose (50 caregivers, 94.3%), and 52 caregivers (98.1%) reported that the defect was improved, which revealed caregivers’ experiences [
46].
In conclusion, the management of children with CLP necessitates a multidisciplinary team, especially in severe cases. All medical and dental professionals share the responsibility of educating caregivers of patients with CLP about the significance of early orthopedic treatment and its role in optimizing future outcomes.
4.1. Strengths and Limitations of the Study
The utilization of a multicenter study design enhances the reliability and robustness of the data collected within regional areas. However, owing to the retrospective nature of the data collection, there is a potential for imprecise information. Therefore, to overcome these limitations, future research endeavors may consider implementing a cross-sectional or prospective study design.
4.2. Implications
The results gained could have a significant impact on public health programs that target CLP patients. Additionally, they can offer evidence-based data to support policy decisions made by authorities on the healthcare management of CLP cases. Educating people about the importance of PSIOs in different areas by using different means and including all age groups could improve the treatment results for this type of patient.